Health-care overhaul could hinge on procedural gamble

WASHINGTON — The best hope for overhauling the nation's health-care system later this year may depend on a procedural change slipped into the House of Representatives' budget bill.

The provision would allow the Senate to approve health-care legislation with a simple majority vote, a change that would block opponents from debating the issue to death.

Usually, 60 votes are needed to limit debate under Senate rules. Since Democrats control only 58 Senate seats, Republican opposition could block a health-care overhaul. The House bill's terms, however, would permit Senate passage with a 51-vote threshold.

The House version of the budget, which passed Thursday evening on a vote of 233 to 196, would allow the Senate procedural change by authorizing what's known as "the reconciliation process." It would permit that process for legislation on health care, education and tax policy.

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Reconciliation was first used in 1980. It's been a common feature of budget resolutions. It was used for President Bill Clinton's welfare changes in 1996, and for President George W. Bush's 2001 and 2003 tax cuts. It's controversial, however, and legislative minorities hate being gagged by it.

The Senate budget doesn't include the "reconciliation" option, but congressional negotiators will resolve differences between the two budget bills later this month, and they could insert the House language into the final bill, facilitating the Senate process change. The Obama administration has said it's weighing whether to support doing it.

The reconciliation process is being considered because Democrats see a rare opportunity to enact a goal that the party's had since Harry Truman was president 60 years ago. Not only is Barack Obama, a popular president, putting his weight behind overhauling health care, he's backed by strong Democratic majorities in both houses of Congress.

Democrats have a 76-seat majority in the House, where Speaker Nancy Pelosi, D-Calif., wants to move quickly.

"The American people want us to find our common ground where we can," she said, "but they did not send us here to split the difference."

A holdup could still come in the Senate. Majority Leader Harry Reid, D-Nev., has been circumspect about whether he'd permit the reconciliation process to ram health-care legislation through his chamber, not ruling it in or out.

Republicans are angry about the prospect.

"It'll be like a declaration of war," said Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health, Education, Labor and Pensions Committee.

Even some Democrats are wary.

"I don't think things should be done this way," Louisiana Sen. Mary Landrieu said of the reconciliation process. "If we're changing the whole system of health care, it needs to be done carefully, with hearings and thorough discussions."

Such uneasiness was apparent Wednesday, when 26 Senate Democrats joined 41 Republicans to pass a measure forbidding reconciliation from being used to pass legislation controlling carbon emissions.

Sen. Barbara Boxer, D-Calif., the chairman of the Senate Environment and Public Works Committee, had pleaded with colleagues to allow the simple-majority option for that legislation too, saying, "It is the way to govern with a majority."

Others, however, wanted to ensure a full airing of all issues surrounding efforts to control emissions, and feared that could be difficult if debate were too limited. "The question is whether technology is sufficient to really control emissions at the level you want," said Sen. Ben Nelson, D-Neb.

While reconciliation has been used before to muscle controversial measures through the Senate, the tactic could present another risk for Democratic lawmakers this year, because

Obama has emphasized the need to try to work with Republicans. This tactic "conflicts with the new bipartisan spirit President Obama promised," Enzi said.

Not so, Democratic leaders countered. Reconciliation is an option that doesn't have to be used — IF a bipartisan consensus can be reached this summer or fall. Then a bill could move forward under standard Senate rules.

"It's a fallback position," said House Majority Leader Steny Hoyer, D-Md., "We want to work together."